- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,993.62 / $2,021.23 / $2,592.31
| Professional | | $1,993.62 | $2,021.23 | $2,592.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,846.00 / $4,615.00 / $6,982.00
| Professional | | $3,846.00 | $4,615.00 | $6,982.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,784.87 / $4,042.45 / $5,528.19
| Professional | | $2,784.87 | $4,042.45 | $5,528.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,509.00 / $8,509.00 / $27,952.00
| Facility | | $8,509.00 | $8,509.00 | $27,952.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,337.69 / $4,144.35 / $7,056.39
| Professional | | $2,337.69 | $4,144.35 | $7,056.39 |